The refusal of significant numbers of parents to vaccinate their children has created a sizable group of people needing very much to be studied, and has raised a number of important public health issues. Foremost among them is the fear that a large reservoir of unvaccinated persons could contribute to epidemic outbreaks that might involve vaccinated individuals as well. Equally pressing are the immediate practical questions of how best to protect the unvaccinated persons from disease, how to prevent such outbreaks if possible, and how to treat them effectively if they do occur.

The long-term question which interests me the most is what the general health of this unvaccinated group will be like, and what we can deduce from this data concerning how vaccines really act.

I would like to begin by proposing that we use the terms vaccinated and unvaccinated instead of immunized and unimmunized, since the basis of the vaccination controversy is the belief of many parents that the vaccines do not produce a true immunity', but rather act in some other fashion--or, in my view, that they act immunosuppressively.

This may sound like a purely semantic distinction, but in fact it bears directly on the first question raised above. If the vaccines conferred a true immunity, as the natural illnesses do, then the unvaccinated people would pose a risk only to themselves. Children recovering from the measles or polio or whooping cough need never fear getting them again, no matter how often they are reexposed in the future. So, the reports of large-scale pertussis outbreaks in the United Kingdom since the vaccine was made optional seem to me a convincing argument against vaccinating anybody, even those who desire it, because if the vaccine produces authentic immunity, then this rebound phenomenon should not occur.

Furthermore, we should be skeptical about the "outbreaks" that are reported to have occurred. Pertussis, or "whooping cough," is actually rather difficult to diagnose conclusively, as it requires special cultures or antibody tests that many laboratories cannot perform and that many doctors, in the presence of suggestive symptoms, rarely take the trouble to order. Conversely, there are other cases of pertussis with typical signs and symptoms but negative cultures and no detectable antibodies. In other words, whooping cough as a clinical syndrome need not be associated with the organism Bordetella pertussis, against which the vaccine is prepared, or indeed with any microorganism whatsoever.

Reservoirs of people unvaccinated against measles, mumps, or diphtheria, on the other hand, should result in periodic outbreaks of these diseases. But again, authentic immunity, would insure that only the unvaccinated would fall ill, which has never proved to be the case. All known out breaks of these diseases in the post vaccine era have included large numbers of vaccinated people as well; an. in many instances a large majority of the cases had previously been vaccinated, some of them quite recently.

The argument that parents should vaccinate their children to protect society as a whole from epidemic does not make sense. Such epidemic argue rather against vaccinating the ones who were vaccinated but still came down with the disease as soon as they were exposed to it. Likewise, if we accept partial or temporary immunity--conceding that the vaccine are not that effective, but that we have no other alternative to these rebound epidemics--then are we not simply throwing good lives after bad, rather like acknowledging that our patients are addicted to dangerous drugs yet fearing to withdraw them or even withhold them from others, lest the original error be fully or frankly exposed?

Richard Moskowitz was born in 1938, and educated at Harvard (B.A.) and New York University (M.D.). After medical school he did 3 years of graduate study in Philosophy at the University of Colorado in Boulder on a U. S.......more

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